The Need for a School Nursing Service in Italy: Time to act

School nurses play an extremely important role in the health and well-being of young people wherever they practice. Many countries around the world have a recognised and established school nursing role – often with some form of regulation, professional body recognition and focused preparatory programmes (CSH, 2016; Hoekstra et al., 2016). School nurses play a key role in promoting the health and well-being of students of all ages within the school environment. To do this, school nurses provide direct care but also work alongside others in the school setting, such as teachers, school staff, and parents. School nurses provide care that address a whole spectrum of health issues in young people; from health education to the management of childhood illnesses and disabilities with a view to ensuring an inclusive and non-discriminatory school environment. The evidence is clear for the impact of school nurses in addressing many of the health issues affecting children and adolescents for example, vaccinations, obesity prevention, mental health, substance misuse prevention, and sex and relationships education (Doi et al., 2018). In some countries, for example the UK, school nurses run health clinics on school premises. Indeed, the recent increase worldwide in the health needs of young people, linked, for example, to an increase in chronic diseases, mental illnesses (especially after the pandemic from Covid-19), sexually transmitted diseases, and obesity rates (Abbas et al., 2023) the school nurse increasingly indispensable.

In Italy, there is no school nursing service and the identity of the ‘school nurse’ is not recognised within Italian nursing systems. At present the management of health needs within the student body is entrusted to different professionals (L. n. 107/15). For example, health education, in the absence of specific regional health programmes, is entrusted to teachers. For some topics, such as the management of illness, this is entrusted to different professionals depending on the nature of the issue and the school grade. For example, neurodevelopment disorders or motor and/or cognitive delays are usually supported by teachers defined as ‘support’. However, for students with high care complexity or extremely compromised levels of autonomy due to these conditions, access to and attendance at high school is often denied, especially if families do not have the economic opportunity to pay for constant private support. For chronic diseases that require drug therapy, such as asthma or diabetes, management changes depending on the grade level and the region. In some regions, until high school, there are local nurses from the public and/or private sector that offer support at certain times of the school day. In other cases, however, the treatment remains the prerogative of teachers, support teachers, parents, or the student itself if able to self-manage its therapy. As for mental health, management is often delegated to services outside the educational institutions. This presents a complex, often uncoordinated picture of school health – one that the presence of a school nurse could greatly improve by coordination, communication, and expert practice.

We believe that the introduction of school nurses and a school nursing service in Italy would provide many benefits, to the individual student and the entire student population. This is also supported by the fact that the National Federation of Orders of Nursing Professions (FNOPI) is beginning to draw attention on this professional (FNOPI, 2020). However, this would require policy changes and financial investments at governmental level. With this editorial, we want to open a professional dialogue through which to start reasoning on this issue and on the possible future introduction of the school nurse in Italy. The hope is that it will be possible to introduce a nursing practitioner who is actively involved in the school system, that will be compatible with the current situation in Italy, and, at the same time, will respond to the needs of young people. This will enable us to promote health education, healthy lifestyles, and proper management of chronic pathologies, which could mean a future generation with a greater empowerment and engagement in its own health and a more inclusive school environment. Similarly, a school nurse would play a fundamental role in the management of student health issues (e.g., epilepsy, diabetes, asthma, neurodevelopmental disorders, mental health problems) by strengthening medical recommendations and providing the necessary health care during school hours. In this way, it is also possible to listen to the students' voices on their state of health and on the school therapeutic environment. In addition, the presence of the school nurse within the school setting, allows a timely health management of any acuity. This strategic position enables school nurses to become a reference point for both students and other educational professionals. Teachers are – of course - central for students, but whose role cannot independently provide for all the health needs of the student population in the way that school nurses do.